Chapters Transcript Postpartum Mental Health and the Parent-Child Dyad Bridget Galati, DO and Jenna Putzel, MD, presents several cases on maternal mortality and the maternal health access project. Well, good morning, everyone. Thank you for joining us for the early bird rounds this morning. Today we have two guest speakers, Doctor Bridget Galotti, who specializes in psychiatry, and Doctor Jenna Putzel, who specializes in general academic pediatrics, and today they'll be co-presenting on postpartum mental health and the parent-child Diad. Before we get started, we have a few announcements. I'm gonna just make sure that we keep our cameras off and our mics muted during the session. And there will be time for questions at the end, and you're welcome to put those in the chat, as always, or to unmute at the end to ask your questions. Um, the QR code will also be put up at the end for um the scan for credit. Um, we'll give them our attention now. Hey, good morning. Um, we really appreciate your time talking to us about this, uh, very important topic for outpatient pediatricians. Um, so we'll go ahead and get started. Um, the title of our talk today is Postpartum Mental Health and the Parent Child Diet, and I'm Jenna Putzel. I'll be doing a case presentation and then handing it over to Doctor Galotti, who is a psychiatrist. We have no disclosures for either of us. Um, and our format will be the clinical case, and then Doctor Galotti will present some info on Missouri maternal mortality, and then talk about the project that we are both working on together to um assist with that Missouri maternal health access project. So here is my clinical case. Um, this is a little person who came to see me. So this is birth record review. Um, 19-year-old G1P1, who is here with her 39 and 27 week infant, um, the baby was born vaginally with vacuum assistance after an induction didn't go completely according to plan, um, and decent size, good Apgars, breastfeeding's all right, discharge Billy wasn't um crazy high. Um, mom's pregnancy was complicated by asthma and anemia, and polyhydramiose, which was resolved. No real remarkable lab. She wasn't immune to chickenpox and she was identified as a CF carrier. So for social history, she lives with her mom and her older sister, who is also due with her second child. Um, during the hospital social work consult, um, about the transition into, when they were discussing the transition into motherhood, she was tearful, but the social work said, you know, she has strong family support and there's openness about depression in the household. Um, they did make a referral to nurses for newborns. Um, so first visit where we meet, Day of life 4, we're feeding well with pump breast milk, urine output is good, normal stools, we're just a couple of ounces below birth weight, so everything pretty as expected. Um, we have a little jaundice with scleroicus, and so we're gonna check another bilirubin. Um, family history is negative for the stuff that we always ask for, like genital hip dysplasia, hearing loss, G6PD. Um, Grandma has some high blood pressure and Grandpa has sickle cell disease. Um, so the concerning part is that her Edinburgh perinatal depression screen is 6, which is not, not super high, um, but Grandma says mom gets overwhelmed whenever she hears the baby cry. Um, so we give a behavioral health response card to the family, um, and they say, you know, we're not gonna see our OB for another 6 weeks. And I say that's, that's OK cause I'm gonna see the baby back in a week anyway, and we'll, we'll check in and see how you're doing. So, at 2 weeks of age, we're, we're almost 2 weeks, we're 12 days of life. We're beating well with pump breast milk, we're above birth weight, umbilical cord stump fell off. We're doing OK. Billirubin repeat was fine, um, little bit of scleroelectrose, but we're OK. Um, so there was a little umbilical granuloma exam. We touched it with silver nitrate. We rechecked that APDS it looks good. So, um, OK, great. So come back in 2 weeks when your baby's 4 weeks old. And so here we are at the one month visit. Um, we're doing OK. We're direct breastfeeding. We've also got the express breast milk. Mom is having some pain with latch, baby's getting some gas drops for belly pain. We're treating her diaper rash with nystatin. Um, but Grandma's with us again today, and she's like, you know, I'm worried about mom, um, and tells mom, you know, and, and asks me to reinforce with mom. She needs to take care of herself in addition to the baby. And then we get another little tidbit of past medical history that mom actually has a history of cutting and depression around age 16, and maybe there was a suicidal gesture at that time, although we're, we don't go into great detail about that. Um, and then Grandma says, you know, I have a history of bipolar disorder and um mom's sister, so other grandma's other daughter who again is about to have a baby, um, also has bipolar disorder. Um, and so we're re-screening for depression, um, with an Edinburgh pretty substantial of 17, uh, so scores above 10 are definitely gonna concern us. So, um, child was in the same system, mom was in the same system, so I was able to message the OB nurse practitioner directly. She's like, yeah, yeah, yeah, I'll see her within 48 hours, not that 6 week thing necessarily. Um, and I talked to Grandma and I talked to the mom, and we can definitely contract for safety, no weapons, you know, people will be with her. Is that OK, um, but they were having trouble with insurance, so, um, I placed a social work referral or my nurse placed a social work referral to make sure that the baby got Medicaid. So that's like our first sort of social contact since the um birth hospitalization. At 6 weeks, we're feeding, we're gaining weight fine. Our diaper rash is still kind of rough. Um, maybe there's still a little bit of a granuloma left at our umbilicus. Um, and they did see their OB nurse practitioner a couple of days after the last visit. She wrote for some Zoloft, um, but our Eperor today is 27. Um, which is pretty, pretty concerning. Um, cause it turns out that we didn't start the Zoloft, so there's a long discussion with mom and grandma on the phone, like she needs to start the Sertralane. It's a safe med. I'm basically just reassuring that absolutely her NP is doing the right thing for her and, you know, trying to be like this is the person to help you, this is a relationship that you should rely on and trust. Um, gave her that 988, the VHR cards again, um, and asked him to come back again in two weeks. Um, we're still working on this diaper rash, which again, like, are we getting all this reimbursement for counseling the mom on postpartum depression? No, but you can certainly go for the diaper rash, right? So Um, now we're 2 months old, uh, Grandma's calling. Mom had woken up with a droopy right side of her face, and there's a concern that maybe there's a stroke happening. Um, she's worried because mom needs to get care, obviously, for sure, but the, um, infant also has a visit scheduled with me today, and I was like, do not worry about the visit with me, just take mom to the hospital. Um, and she's seen at the hospital and they call it a stress reaction, not an actual stroke. Um, and they are still making it for that appointment with the baby because he's had a cough for a couple of weeks, he's been fussy for a week, um, and the diaper rash is ongoing. Additionally, um, the preschool aged cousin dropped him, getting him out of the swing a few days ago, and he landed face down and so we're worried that like something could have happened to him even though he's been Fussy but not vomiting, no loss of consciousness. So, um, my nurse helps me move heaven and earth. We get a same day head ultrasound, we swab the kid, um, and then we're gonna wipe out this diaper rash once and for all with some oral fluconazo. Um, so they come back in a month, and everybody's sick, all the cousins, the parents, the grandma, um, and I'm just asking some more details, like, hey, you know, you said something about a stress reaction, um, and Grandma's like, yeah, yeah, yeah, that was, that was migraine related. I'm like, oh, OK, OK. But mom's doing better, she's taking the sertraline, she has follow up scheduled to um ensure that she gets her own mental health care. Um, so we are back for our follow-up visit. We're 4 months old coming in for our shots, right? Um, our cold's all better now we got a little eczema. Mom's EPDS is substantially improved. It's down to 12. Um, and I was like, that's great. Keep taking your sertraline, keep seeing your NP. And we're gonna treat your eczema. Um, and then at the follow-up visit after the 4 month visit, um, we were checking to make sure that the Elidel, the hydrocortisone, and the Vaseline were helping. They did help. Mom looks great. We skipped the EPDS, uh, depression screen at that visit. Um, and then we don't make our 6 month visit. Um, mom does call us 2 weeks after the visit was supposed to happen, and she's worried that the baby has fallen out of the bassinet. So make another referral to social work because I'm like you, your baby is probably too big for a bassinet, um, and social work note says that there's no no behavioral health concerns. Um, and then they missed the rescheduled appointment, and then they missed the rescheduled rescheduled appointment. So, um, the next time I'm gonna see this baby is 8 months of age, so we've got this like 4 month care gap sort of. We're still in contact though, always by phone. So the eight month visit, our skin's all better. Um, we don't have our safe crib yet, but um we also could use some diapers, so there's some, some financial stressors happening. Um, Mom has an appointment scheduled with a psychologist and is um gonna get to see a new primary doctor in September for her mood problems since um stopping her sertraline. Grandma says they had tried to call the OB office, but the front desk declined to schedule her an appointment for a quote unquote non-gynecologic problem. Um. But the problem is not gynecologic, but it is certainly postpartum related. Her Edinburgh perinatal depression screen today is 26 and on question 10 of that EPDS she's endorsing suicidal ideation um without any plan or intention. So, again, we're at this visit. Mom and grandma um are able to contract for safety. Um, I'm making a referral to the maternal health access project that we'll get more into with Doctor Pilate's portion. Um, I want coordination of care for her through that as well as a possible psychiatry cons um consultation. Um, in my clinic, fortunately, we have a half day a week where, where we have, um, a child and adolescent psychiatrist co-located in my practice, um, and so I'm like, you know, we're gonna try and double, triple cover this, so we're gonna send her to him. I re-messaged the OB nurse practitioner about restarting the med, letting her know that the patient um is is again experiencing suicidal ideation. Um, again, the HR, um, resource is given, um, talked about why to call 988 when mom's in crisis, um, and I want to see them back in 3 weeks, but we're gonna continue to follow up by phone closely within 1 to 2 days. Um, and so, the month passes before I see them next. Um, they had gone to the ER for wheezing, the baby's got rhinoentro, now doing better. Um, the stressors are sort of piling up. Family finds out they're gonna move at the end of next month because there's an issue of housing insecurity. Um, the maternal Health Access Project did call mom with therapy resources, according to Grandma, but mom didn't call him. RAPDS is still pretty, pretty close to the max of where it could be at 27. There is some occasional suicidal ideation. Um, Mom has an appointment with the OB nurse practitioner in 2 weeks, and the psychiatrist in my office in 4 weeks, and I'm like, look, we, we just really need to intervene at the moment, and so, I'm like, would you, if I send the prescription in, are you amenable to restarting the Zoloft? And she said, yeah, I'll, I'll do that. I'll take the med. Um, and they're still able to contract for safety. Again, BHR info is reiterated. Call 998 if mom's in crisis and come back again and see me in two weeks. So this was the sort of supposed to be the epilogue, so they don't come for the appointment, um, but Grandma is bringing the cousin for a visit and she updates me that um mom has never started the sertraline. She did see the OB nurse practitioner for her visit, um, was negative for suicidal ideation on her depression screener, um, but still with that very high total score of 25. Um, she told the NP she didn't want medication, she wants therapy. Um, social worker within the OB clinic spoke to her. There was no full note in, um, but there was brief discussion of like finding therapy and psychiatry resources covered by her insurance, and they referred to parents as teachers. Um, and asked to come back in 3 months with a psychiatry appointment that um we had arranged for 3 weeks. Um, that same day, I get an email from the internal Health Access Project saying that after repeated attempts to connect with, with her mom had asked them to stop calling. So this was a, a pretty defeated feeling day. um, and I was like, oh my gosh, all this effort, and we're really trying to help this mom, and it's going nowhere. But, um, Grandma was like, you know what, I will get mom to bring the baby back next week and we will, we will continue to work on it. And I say, you know, OK, obviously because I care very much about this family and um I wanna do whatever I can to help them. And so the epilogue to the epilogue is that this week, one week later, um, mom, baby, grandma, maternal aunt, and two cousins all showed up for the follow-up visit, and mom's actually been taking her sertraline for 4 days. Um, she had decreased some of her, um, other, uh, coping mechanisms which were not helping, um, with THC use and her um her depression screen is down to 15 with no suicidal ideation. Um, our discussion with mom is that she never got the resources for maternal health access project, even though I do have some pretty good intel that that she asked them to stop calling her, but because they emailed me these resources, I was able to give mom a therapy resource that accepts her insurance and offers in-person visits in the area, and mom will have a visit with psychiatry here at Children's uh in a week. So I'm gonna hand it over to Doctor Galotti. I'm actually just gonna switch seats with her, so, here we go. Thanks Doctor Petzel, so, um, now we're gonna certainly switch gears and kind of talk a little bit more in detail about maternal mortality, uh, within the state. Um, so within the past few weeks, the Department of Health and Senior Services released the most recent PAR, so the pregnancy-related mortality Review, um, from 2017 to 2021, and this showed that there was a mortality ratio of 32.2 per 100,000 live births. Um, the leading cause of death during this time was due to cardiovascular disease. However, mental health conditions, including substance use disorders, was the 2nd leading cause of death. There's a few different striking differences between the CDC data that uh calculates state maternal mortality. Um, in comparison to the PMR, and one of them, um, is certainly the time frame. So the CDC National Center for Health Statistics does not include maternal mortality deaths, um, post 42 days postpartum. So during the late postpartum period, which includes 6 weeks to 12 months, and you can see that by the cutoff on this figure. Um, another kind of striking difference between the CDC and the Palmer. Is that the CDC does not include deaths from accidental or incidental injuries, including mental health conditions such as overdoses, um, and they define deaths a little bit differently with the MMR and one of those kind of differences is, um, CDC only includes pregnancy-related deaths, so deaths directly from the results of pregnancy or do causes from pregnancy or physiological changes from pregnancy. Um, but the Palmer is a more inclusive review of all maternal deaths within the state, and that includes also pregnancy associated deaths that are shown here in purple. And just briefly looking at this data, you can see that majority of deaths were defined as pregnancy associated and occurred during that late postpartum period. In looking a little bit closely at some of this data, obviously we see that cardiovascular disease was the leading cause of pregnancy-related deaths during this time period. However, when we focus on just the late postpartum period, as in blue, we see that the leading cause of death during this time period is actually mental health conditions. And just to go a little bit deeper into where um individuals are dying, this map shows that the actual number of deaths per location of residents, and majority of these deaths occurred in metropolitan areas, particularly Saint Louis, um, and Kansas City. When the state tries to calculate now, um, the ratio, the mortality ratio, they group these counties together into these seven separate regions, and this allows for um the calculation of this mortality rate. You can see in the urine color that the northeastern region had the highest pregnancy-related mortality of 41.5, and remembering that our state average mortality ratio was 32.2, so much higher. However, looking at a little bit more closely, we see that the Saint Louis metro region here in yellow has the 2nd highest mortality ratio compared to all of the other regions, following obviously the Northeast. And looking also at the data, you can see that the majority of these deaths occurred within the Saint Louis metro region. The Palmer has a much higher maternity mortality rate compared to the CDC. From 2018 to 2022, the CDC maternal mortality rate within Missouri was 23.8. Um, and so, because the PA includes more inclusive data and includes a little bit more um pregnancy associated causes as well, we're able to probably account for that higher increase in mortality. There were several demographic disparities that were found of the women that died within the state of Missouri during this time period. Um, individuals who had a high school diploma or GED were 3 had a 3.3 times higher mortality rate than those who had higher educational attainment. Individuals who had Missouri Health Net had a 2.8 times higher mortality ratio compared to those with private insurance, and individuals who resided in metropolitan counties had a 1.5 times higher mortality ratio compared to those in rural. There certainly were um racial disparities that were found within the data and um although white women accounted for the majority of all live births, 75% of live births within the state of Missouri, black women had a mortality ratio 2.5 times higher than other demographics. And this is shown in 3-year intervals on the left. You can see that blacks are identified in orange, and then all of the data is summed over the 5-year period to the right, where you can see this displayed. Going a little bit deeper into kind of the breakdown of pregnancy-related deaths. We're gonna focus on mental health conditions. Um, in the beginning, I showed a slide of pregnancy-related deaths and pregnancy associated deaths, and sometimes the next few slides will kind of go back and forth between two of those different classifications. Really just wanna probably focus on overarching that these deaths were associated with pregnancy, whether directly or indirectly, and I'll kind of try to point out those differences. Um, but for the most part, we're gonna really focus on the overarching picture of the impact of mental health conditions. So during this time period, mental health conditions accounted for the 2nd leading cause of pregnancy-related deaths, a little over 50% were attributed to depression or anxiety disorders, and a little less than 50% were attributed to substance use disorders. The Palmer board To find though that 100% of all these pregnancy-related deaths due to mental health conditions, including substance use disorders, were determined to be entirely preventable. In looking at some of the demographics of individuals that died secondary to mental health conditions, majority of these individuals were white women who lived in metropolitan counties, and most had Missouri Health Net insurance. Of those that died by overdose, most involved multiple substances. And there were several psychosocial stressors that were identified um in the context of these deaths. Most of these individuals had a history of substance use and may have struggled with unemployment or involvement with CPS. We look particularly at the suicides that occurred during this time period. Suicides accounted for 14% of all pregnancy-related deaths within the state, and nearly half of these suicides occurred during 2020. The most common means of fatal injury was firearm, and the majority of them occurred during the late postpartum period. Most were white women who lived in metropolitan counties, and most had initiated prenatal care during the first trimester. The board examined several psychosocial factors that add context to these pregnancy-related deaths, and as you can see some of the leading identified stressors were noted here, particularly a history of substance use, unemployment, CBS involvement, a history of domestic violence, history of psychiatric treatment, and even fewer have actually received treatment for substance use disorders, identified as 11% in the blue. When we look at mental health conditions and isolation other than substance use disorders, of the women that died, a little over 50% had received treatment for depression prior to this most recent pregnancy. But over time, and during the pregnancy and postpartum, fewer had received treatment for depression. In those that experience anxiety disorders, you can see a little over 1/3 received treatment for an anxiety disorder prior to the most recent pregnancy. However, during pregnancy and postpartum, fewer had received treatment. In specifically examining substance use disorders and overdoses, for pregnancy-related deaths, the most common means of fatal injury was overdose. Poisoning and overdose were the most common means of pregnancy associated deaths due to accidental injury within the state. Followed by motor vehicle accidents. And looking at this data, you can see that most women with substance use disorders are not receiving treatment. Some had also experienced significant stressors such as unemployment and CPS involvement. Of the women that died secondary to an overdose, most were white, most were young, aged 20 to 29 years of age. Most resided in metropolitan counties, most had Missouri health insurance. Most of these overdoses involved multiple substances shown here um in orange, the orange bar that shows total polysubstance use. So most of the dots involved more than one substance and primarily that included an opioid and shown in blue, including fentanyl, oxycodone, morphine. Etc. In conjunction with another substance such as stimulants and green, so methamphetamine, cocaine, prescription stimulants, or an opioid in conjunction with the benzodiazepine, such as Xanax, Ativan, Klonopin. I included this slide here because I felt like it was really imperative. Um, a lot of the individuals, um, These deaths could be prevented as well, and homicide, you may not see is not related to mental health conditions. But I think this is a real huge gap in care for our moms, particularly during the postpartum period. Homicides were the 4th leading cause of pregnancy-related death within the state. The most commonly occurred via firearm. Most occurred during the late postpartum period, so 6 weeks to 12 months postpartum. All occurred within metropolitan counties, and each perpetrator was a current or former partner and had most had a documented history of in partner violence. The Per uh board came up with several recommendations that um providers can, um, hopefully enact on to improve and reduce maternal mortality within the state. And although the majority of deaths occurred during the late postpartum period, early identification and treatment are certainly essential to preventing precaution and some of these deaths. They recommended that all providers ask about firearm possession and provide education and safe storage. They recommended that all providers screen women for in partner violence and certainly perform assessments for depression, anxiety, substance use disorders using standardized validated tools during pregnancy and postpartum. They recommended that all providers also refer individuals who were screening positive for those conditions to treatment. They also recommended that women during pregnancy and postpartum are provided education about the signs and symptoms and risks of postpartum depression and additional resources. They recommended that providers themselves further their own education regarding screening, and treatment of mental health conditions, including substance use disorders during pregnancy and postpartum. They recommended that providers also complete trainings on trauma informed care and certainly provide Narcan to those at high risk. And so if you're just kind of coming back into focus or paying attention, hopefully not, but if you didn't kind of, you know, gather from the clinical case presentation or the slides that we've presented so far, um, you know, that you're still wondering, well, I care for pediatric patients, why should I really care about maternal health conditions? And I think certainly as pediatric providers, you all know that there's significant negative outcomes in infants or children um who are exposed to untreated maternal mental health conditions, and those include negative neural development outcomes in children, or um lack of healthcare, utilization, neglect, abuse, impaired bonding with infant or child, relationship or marital issues within the family unit, and then certainly severe things like suicide, overdose, and feicide. As certainly as pediatric providers, we feel that you can be a part of the solution and filling the gap and helping screen and assess these individuals, although they are not your patients directly during these high risk times, particularly that late postpartum period, as they might be showing up accompanying their child to those wellness visits. And then in also in the case presentation that Doctor Putzel presented, they might be your patient directly. They might be a teenage mother who is at incredibly high risk of depression and postpartum anxiety and other psychiatric conditions, and they might be the ones that you need to seek um help and uh continue assessing and connecting them with care. And so that's where the Missouri Maternal Health Access Project comes into play. Um, we really want to thank our funders, the Missouri Department of Health and Senior Services, as well as the HRSA grant who provide substantial funding for this project. Um, Governor Parsons created the maternal mortality prevention plan that includes these five components or domains, and Maternal Health Access Project is one of those domains, in addition to improving maternal quality protocols, healthcare workforce, optimizing postpartum care, and improving healthcare um data regarding maternal mortality within the state. So what is MHAP? MHAP is now a statewide perinatal access program that is designed to forgive providers, any individual that comes in contact with a pregnant or postpartum patient up to those 12 months postpartum, the tools they need to diagnose, treat, access care for their patients with psychiatric or mental health conditions. There's 3 components of them that we're gonna briefly talk about, including psychiatric consultation, care coordination, and then training and education. So we want to stress that MHAP is not just for prescribers, it's for any provider or not provider, any individual that comes in contact with that pregnant or postpartum patient up to the 12 months postpartum. And that includes certainly pediatric providers like yourselves who might be seeing the infants um at those well child visits or sick visits. Um, we wanna, you know, really stress that this is for any individual that comes in contact with these patients, uh, whether they're caring for them directly or not, including social workers, doulas, home visitors, pediatricians, pediatric providers, OBGines, um, psychiatrists, primary care providers, etc. In order to utilize MAP, providers must be registered, and there's a QR code to our link to register. Um, the registration process takes about 5 minutes. All of the services that we provide are free. Um, once you register, you'll receive an email that has additional information regarding scheduling, psychiatric contact, the access phone number, online scheduling, as well as some additional informational materials. And we'll um share this QR code as well a little bit later in the presentation if you didn't have enough time to scan right now. Um, so, going into the psychiatric consultation portion, so in order to schedule that, obviously you have to be registered initially, then you'll have access to the phone number that you can call 24/7-365, or you can schedule an online request using our online scheduling for. Um, our services are answered by BHR and although our providers are only available during the hours of 9 a.m. to 4:30 Monday through Friday, our phone lines are always available 24/7 365. So you can certainly schedule consultations if you happen to call outside of those hours. It'll just be for those times that um the provider is available Monday through Friday 9 to 4:30. You can have um requested a consult within 30 minutes, or you can schedule at a later date. The psychiatrist will call you directly, and then following the phone call, you'll receive an email summary of what was discussed. There's a variety of topics. We certainly welcome any and all calls, um, from launching our phone lines in April of this past year, we've received a variety already. um, that can be for diagnostic clarification, titration of medication, preconception medication counseling, safety with lactation, or being that bridge to care while a patient is awaiting psychiatric care. Um, we really want to stress and given the data that substance use disorders was a leading cause of death, whether pregnancy related or pregnancy associated within the state during this five-year period and continues to be a huge cause of mortality within the state. Um, myself and Doctor Kim Brant, um, also have additional certification, board certification in addiction medicine, and we treat pregnant postpartum patients with substance use disorders routinely in care. Here at Barnes, I treat patients within the care clinic, the clinic for acceptance, recovery and empowerment in pregnancy and postpartum, which is a um clinic that's embedded within maternal fetal medicine outpatient in the CO, and we have a multidisciplinary staff where we're able to treat pregnant and postpartum patients up to 3 years with substance use disorders and other co-occurring psychiatric conditions. And so we really want to increase education, awareness, and access to treating substance use disorders in this population, and so we welcome it certainly any calls about maybe starting medication for opioid use disorders such as buprenorphine or methadone, considerations around labor and delivery, particularly with pain management and concurrent MOUD treating other substance use disorders such as stimulant use, tobacco or alcohol use disorders in pregnancy or postpartum, management and certainly lactation considerations. Um, we certainly welcome any topics from other providers, and that might be, you know, help with you performed in EPDS. The patient is scoring pretty high. Now, what do I do? Um, triaging, what are the next steps in care, and how do we connect that patient with care. Um, helping interpret results from a screening questionnaire, helping, um, understand, um, symptoms that a patient might be reporting, um, or just helping them advocate for psychiatric care. The second component of MHAP is certainly a care coordination piece, and there's two kind of direct routes that we're able to provide care coordination resources to patients. One on the right is that we would contact you, the provider directly and provide those resources for the patient. And then, like Doctor Petzel did in that situation, she was able to provide those resources to the patient directly in those appointments. The other portion or the other option is to have um the care coordinator contact that patient directly. So you would pass on the patient's contact information, the care coordinator will contact that patient directly and provide those additional resources that the patient is needing and continue to follow up with them until they at least have attended two appointments or the patient has told them stop calling them. Some of the resources that a care coordinator can connect a patient with include, you know, substance use disorder treatment, whether that's an intensive outpatient program, residential, individual or group therapy, home visiting, other additional support groups, or certainly primary or psychiatric care. The other component of MHAP is education and training, and although our website is currently in development, we hopefully will be launching it soon and we'll have access to tool kits with additional um education and information about the assessment and screening and management of mental health conditions, including substance use disorders in pregnant and postpartum patients. We also, as registered providers send out uh routine updates via email with educational information and additional learning opportunities, and then we're performing educational trainings. Two of the trainings that we actually have scheduled for later this month, um, on Monday, October 28th, and then Tuesday, October 29th. We're gonna be focusing on perinatal anxiety disorders including trauma and OCD and on Monday, the emphasis on really is on non-pharmacological management, and Tuesday it's um on pharmacological management for those conditions. Some of the frequently asked questions that we've received, um, is can can perinatal patients call our hotline directly and talked with a perinatal psychiatrist? No, unfortunately at this time, we are only a service for providers. Um, do we offer one on one patient consultations? Not yet. Um, we are just currently providing care for providers and that consultation and additional resources. Um, so we, um, request that you do not share the, the hotline or the online scheduling with patients. Directly. Um, is there a limit to the number of times that a patient can call, excuse me, a provider can call? No, we certainly welcome any and all calls and, you know, throughout the journey of seeing patients or maybe it's not your patient, um, you're interacting with that mom during those wellness visits or sick visits, um, you know, we love to hear updates. We'd love to also help along that journey and connecting that patient or helping you through that care. Um, and then what is the cost to patients? So nothing, all of the care coordination services are free. The services that a patient may access in terms of therapy or other support services may have a cost affiliated with them, um, and that is something that the care coordinator will do their best to individualize the resources that they provide to that patient so that they are readily accessible. Um, but the, the actual service of the care coordinator providing that care resources to the patient are free. Um, there certainly are significant gaps in maternal psychiatric and mental health care within the state. Um, and one of the things that, um, MAP is doing to kind of bridge this gap is we're working on unifying with our sister, uh, most CPAP that you might all be familiar with and hopefully registered with. And we're gonna be forming kind of, uh, under kind of the overarching um University of Missouri Center for Child Wellness where we can tandem together and really improve care for families within the state. We're continuing to promote educational training, so look out for emails from those if you register and then um hopefully we'll be launching our website soon with additional resources and tool kits. And then one of our long-term goals is, uh, to be able to provide that one on one consultation with patients, where the perinatal psychiatrist can meet with the patient, have a consultation, and then make recommendations regarding treatments or diagnostic clarification, and to that provider and helping them, uh, connect that patient with additional care. Um, that would just be a one-time consultation and not taking over care of that patient. They would just be consultation recommendations. But we're hoping to implement that within the next year. Um, here's the QR code, um, that you can scan to, uh, register. Um, we certainly welcome any questions. We have some of our team members on the call today that can help as well. Um, you can email us directly at the email address or you can copy that link and go to the website directly. Thank you. Created by Presenters Bridget Galati, DO Assistant Professor, Psychiatry View full profile Jenna M. Putzel, MD, MPH Pediatrics, General Academic Pediatrics View full profile
